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Onward,
Alexander, Jeffrey, Becky and Deva
Weekend
Edition
November 18 / 19, 2006
California Medical Survey
The
Adverse Effects of Marijuana
By FRED GARDNER
In the past 10 years, California doctors
have authorized cannabis use by at least 350,000 patients. What
have they learned about its adverse effects?
According to a survey of 19
doctors associated with the Society of Cannabis Clinicians, side-effects
are relatively rare, mild, and transient. There have been no
deaths, no major adverse events attributed to cannabis -with
one exception involving a claim by an establishment psychiatrist
that cannabis induced and exacerbated psychosis in an 18-year
old whom she had on a regimen of Lexapro and Zyprexa.
Comments by the SCC doctors
follow.
Frank Lucido, MD: Reported
adverse effects are rare, in part because the patient coming
to a medical cannabis consultation has already found cannabis
to be of benefit. (I have had perhaps 10 patients in 10 years
who had never tried cannabis or who hadn't used it in many years
and were uncertain if it would effectively treat their current
illness or symptoms.) Two patients have discontinued use in response
to decreased productivity. The overwhelming majority report that
they are MORE productive when their symptoms are controlled with
cannabis.
Robert Sullivan, MD: None
common (c. 1%), none "serious." Weight gain, tolerance,
anxiety (related to potential theft from an outdoor garden),
dry mouth, short-term memory decrease, anxiety, red eyes. All
described in response to my inquiry (not spontaneous). None resulted
in stopping cannabis use.
Marian Fry, MD: The most significant
negative reactions are due to fear of incarceration and the results
of abuse by officers unwilling to honor California law.
William Toy, MD: The most
important adverse effects are respiratory problems caused by
smoking. Most patients who have respiratory problems use vaporizers
or edible forms of cannabis. We go out of our way to get patients
on vaporizers and we now have only a small percentage of smokers
-mostly people who have been smoking marijuana for 30-40 years.
Most in this group use very little, maybe one or two doses a
day.
Philip A. Denney, MD: Virtually
none reported by patients except contacts with the legal system.
Patients are able to stop using easily in order to pass drug
tests or when traveling. Overdose from edible cannabis -an unpleasant
drowsiness lasting six to eight hours- is rare and transient.
David Bearman, MD: Occasional
complaints of cough. Many more complaints about Marinol than
cannabis -dysphoria, ineffective, costs too much.
Tom O'Connell, MD: The most
common is the "paranoid" reaction, in which, characteristically,
a user who is "high" develops the uncomfortable feeling
that everyone he/she sees KNOWS they are high and is critical
of them for it. It almost always occurs in a situation where
the person may be forced to deal unexpectedly with the public.
It certainly needs further study. In any event, patients deterred
from using pot aren't lining up for approvals to do so.
William Courtney, MD: A significant
number of my middle-aged patients are no longer enamored of the
psychoactive effects that previously were the highlight of their
cannabis use. For them, what was euphoric has now become dysphoric.
Such patients tolerate the anxiogenic properties in order to
enjoy the anti-spasmodic or analgesic effects -much as a patient
on chemotherapy reluctantly accepts the nausea in exchange for
the anti-tumor effects. While a few patients have discovered
that there are strains that provide relief without dysphoria,
others are excited by the possibility of daytime CBD analgesia
or autoimmune modulation without alteration of their sensorium.
Dr. A.: We've had several reports
of hypotensive reaction -a sudden drop in blood pressure, which
results in fainting. It's very rare and, as reported by my patients,
is a one-time thing. It typically happens after a big meal, when
the GI tract is opened up and absorbing a lot of blood.
Jeffrey Hergenrather, MD: Is
there a downside to the use of cannabis? The sense of intoxication
rarely lasts longer than an hour and tends to be more troubling
to the novice than to the experienced user. For some people cannabis
can induce dry mouth, red eyes, unsteady gait, mild in-coordination,
and short-term memory loss, all of which are transient. These
effects are reportedly trivial compared to those brought on by
pharmaceutical alternatives.
Cannabis use is steadily finding
acceptance in society. Still, for many it remains awkward if
not totally impractical in the workplace. People whose jobs require
multi-tasking such as pilots, drivers, dispatchers, switchboard
operators, and many professionals find the intoxicating effects
of cannabis inappropriate in the workplace, and therefore reserve
their use for after work.
The survey, conducted by your
correspondent for the upcoming issue of O'Shaughnessy's (and
previewed exclusively on CounterPunch), does not pretend to be
rigorous. It involves the patient population least likely to
experience adverse events and a setting in which adverse events
might be downplayed (examinations in which the patient is seeking
the doctor's approval to use). As Dr. Lucido and others point
out, in the first 10 years of legality created by Prop 215, almost
all the patients seeking physician approval to use cannabis had
been self-medicating previously with positive results. Truly
naïve patients have been rare -and those experiencing unwanted
side-effects would be unlikely to return to the doctor for a
renewal, i.e., their complaints would go unreported.
The charge that cannabis use
caused and then increased the severity of a psychotic break in
an 18-year-old was made by a Stanford University psychiatrist,
Dr. P., who filed a complaint with the state medical board against
the doctor who had approved it. "I believe THC caused his
depression to worsen, interferes with antidepressant meds, and
clearly caused his psychosis," Dr. P advised the board.
"He is also psychologically and physically dependent on
the substance. He refuses to quit. He even admitted to seeking
the medical marijuana justification in order to use regularly
'legally.'"
The assumption that marijuana
causes physical dependence is without scientific foundation.
Dr. P.'s use of the term "even admitted" reveals a
prosecutorial frame of mind. She seems appalled to learn what
all cannabis consultants know and what should come as no surprise
to any person with common sense: feeling legitimate relieves
anxiety! Dr. P.'s treatment of the mutual patient involved anti-marijuana
exhortations and the pushing of her preferred corporate drugs.
Lexapro is an SSRI antidepressant made by Forest Pharmaceuticals.
Like all SSRIs it is slowly but surely being linked to suicide
in the medical literature (while the drug companies and their
paid researchers in the psychiatric establishment challenge each
piece of evidence).
Dr. P.'s allegation that marijuana
use precipitated and aggravated the patient's break with reality
can't be proved or disproved. Some published studies indicate
an "association" between marijuana use and schizophrenia,
but not necessarily a causal relationship. (A person seeing demons
or hearing voices may use cannabis because he finds that it quiets
them.) Schizophrenia occurs in about 1% of adult populations
in all countries and cultures, regardless of the prevalence of
cannabis use. The use of Marinol (synthetic THC) by teenage cancer
patients has not resulted in an increased incidence of schizophrenia.
Ironically, the component of
the cannabis plant thought to have sedative and anti-psychotic
properties -Cannabidiol (CBD)- is present only in trace amounts
in the strains available to California patients. As indicated
by Dr. Courtney, the SCC doctors are frustrated that they don't
know the cannabinoid contents of the herbs their patients are
using. They all wish a high-CBD strain was available. They would
have learned a lot in 10 years about how it differs from high-THC
cannabis. Prohibition sabotages research.
Fred Gardner is the editor of O'Shaughnessy's
Journal of the California Cannabis Research Medical Group. He
can be reached at: fred@plebesite.com
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